2010 California Code
Welfare and Institutions Code
Article 3. Services And Standards

14550.  Adult day health care centers shall offer, and shall provide
directly on the premises, at least the following services:
   (a) Rehabilitation services, including the following:
   (1) Occupational therapy as an adjunct to treatment designed to
restore impaired function of patients with physical or mental
limitations.
   (2) Physical therapy appropriate to meet the needs of the patient.
   (3) Speech therapy for participants with speech or language
disorders.
   (b) Medical services supervised by either the participant's
personal physician or a staff physician, or both, which emphasize
prevention treatment, rehabilitation, and continuity of care and also
provide for maintenance of adequate medical records. To the extent
otherwise permitted by law, medical services may be provided by nurse
practitioners, as defined in Section 2835 of the Business and
Professions Code, operating within the existing scope of practice, or
under standardized procedures pursuant to Section 2725 of the
Business and Professions Code, or by registered nurses practicing
under standardized procedures pursuant to Section 2725 of the
Business and Professions Code.
   (c) Nursing services, including the following:
   (1) Nursing services rendered by a professional nursing staff, who
periodically evaluate the particular nursing needs of each
participant and provide the care and treatment that is indicated.
   (2) Self-care services oriented toward activities of daily living
and personal hygiene, such as toileting, bathing, and grooming.
   (d) Nutrition services, including the following:
   (1) The program shall provide a minimum of one meal per day which
is of suitable quality and quantity as to supply at least one-third
of the daily nutritional requirement, unless the participant declines
the meal or medical contraindications exist, as documented in the
participant's health record, that prohibit the ingestion of the meal
at the adult day health care center. Additionally, special diets and
supplemental feedings shall be available if indicated.
   (2) Dietary counseling and nutrition education for the participant
and his or her family shall be a required adjunct of such service.
Dietary counseling and nutrition education may be provided by a
professional registered nurse, unless the participant is receiving a
special diet prescribed by a physician, or a nurse determines that
the services of a registered dietician are necessary.
   (e) Psychiatric or psychological services which include
consultation and individual assessment by a psychiatrist, clinical
psychologist, or a psychiatric social worker, when indicated, and
group or individual treatment for persons with diagnosed mental,
emotional, or behavioral problems.
   (f) Social work services to participants and their families to
help with personal, family, and adjustment problems that interfere
with the effectiveness of treatment.
   (g) Planned recreational and social activities suited to the needs
of the participants and designed to encourage physical exercise, to
prevent deterioration, and to stimulate social interaction.
   (h) Transportation service for participants, when needed, to and
from their homes utilizing specially equipped vehicles to accommodate
participants' needs. The transportation service may only exceed one
hour when necessary to ensure regular and planned attendance at the
adult day health care center and when there is documentation in the
participant's health record that there is no medical
contraindication.
   (i) Written policies and procedures for dealing with natural
disaster and emergency situations.



14550.5.  Adult day health care centers shall offer, and provide
directly on the premises, in accordance with the participant's
individual plan of care, and subject to authorization pursuant to
Section 14526, the following core services to each participant during
each day of the participant's attendance at the center:
   (a) One or more of the following professional nursing services:
   (1) Observation, assessment, and monitoring of the participant's
general health status and changes in his or her condition, risk
factors, and the participant's specific medical, cognitive, or mental
health condition or conditions upon which admission to the adult day
health care center was based.
   (2) Monitoring and assessment of the participant's medication
regimen, administration and recording of the participant's prescribed
medications, and intervention, as needed, based upon the assessment
and the participant's reactions to his or her medications.
   (3) Oral or written communication with the participant's personal
health care provider, other qualified health care or social service
provider, or the participant's family or other caregiver, regarding
changes in the participant's condition, signs, or symptoms.
   (4) Supervision of the provision of personal care services for the
participant, and assistance, as needed.
   (5) Provision of skilled nursing care and intervention, within
scope of practice, to participants, as needed, based upon an
assessment of the participant, his or her ability to provide
self-care while at the adult day health care center, and any health
care provider orders.
   (b) One or both of the following core personal care services or
social services:
   (1) One or both of the following personal care services:
   (A) Supervision of, or assistance with, activities of daily living
or instrumental activities of daily living.
   (B) Protective group supervision and interventions to assure
participant safety and to minimize the risk of injury, accident,
inappropriate behavior, or wandering.
   (2) One or more of the following social services provided by the
adult day health care center social worker or social worker
assistant:
   (A) Observation, assessment, and monitoring of the participant's
psychosocial status.
   (B) Group work to address psychosocial issues.
   (C) Care coordination.
   (c) At least one of the following therapeutic activities provided
by the adult day health care center activity coordinator or other
trained adult day health care center personnel:
   (1) Group or individual activities to enhance the social,
physical, or cognitive functioning of the participant.
   (2) Facilitated participation in group or individual activities
for those participants whose frailty or cognitive functioning level
precludes them from active participation in scheduled activities.
   (d) One meal per day of attendance, in accordance with Section
54331 of Title 22 of the California Code of Regulations, unless the
participant declines the meal or medical contraindications exist, as
documented in the participant's health record, that prohibit the
ingestion of the meal.



14550.6.  Adult day health care centers shall offer, and provide
directly on the premises, in accordance with the participant's
individual plan of care, and subject to authorization pursuant to
Section 14526.2, the following core services to each participant
during each day of the participant's attendance at the center:
   (a) One or more of the following professional nursing services:
   (1) Assessment and monitoring of the participant's general health
status and changes in his or her condition, risk factors, and the
participant's specific medical, cognitive, or mental health condition
or conditions upon which admission to the adult day health care
center was based.
   (2) Monitoring and assessment of the participant's medication
regimen, administration and recording of the participant's prescribed
medications, and intervention, as needed, based upon professional
assessment of the participant's reactions to his or her medications.
   (3) Oral or written communication with the participant's personal
health care provider, other qualified health care or social service
provider, or the participant's family or other caregiver, regarding
changes in the participant's condition, signs, or symptoms.
   (4) Provision of skilled nursing care and intervention, within
scope of practice, to participants, as needed, based upon an
assessment of the participant, his or her ability to provide
self-care while at the adult day health care center, and any health
care provider orders.
   (b) Personal care services or social services, or both, needed to
address the person's individual needs for benefits as required by
Section 14525.1, as follows:
   (1) Protective group supervision and interventions to ensure
participant safety and to minimize the risk of injury, accident,
inappropriate behavior, or wandering.
   (2) Assessment, and monitoring of the participant's psychosocial
status provided by the adult day health care center social worker or
social worker assistant.
   (3) Group work to address psychosocial issues.
   (c) At least one of the following therapeutic activities provided
by the adult day health care center activity coordinator or other
trained adult day health care center personnel:
   (1) Group or individual activities to enhance the social,
physical, or cognitive functioning of the participant.
   (2) Facilitated participation in group or individual activities
for those participants whose frailty or cognitive functioning level
precludes them from active participation in scheduled activities.
   (d) One meal per day of attendance, in accordance with Section
54331 of Title 22 of the California Code of Regulations, unless the
participant declines the meal or medical contraindications exist, as
documented in the participant's health record, that prohibit the
ingestion of the meal.
   (e) This section shall only be implemented to the extent permitted
by federal law.
   (f) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement the provisions of this section by means of
all-county letters, provider bulletins, or similar instructions
without taking further regulatory action.
   (g) Upon the date of execution of the declaration described under
subdivision (g) of Section 14525.1, this section shall become
operative and Section 14550.5 shall become inoperative and on that
date is repealed.


14551.  The following additional services may also be provided:
   (a) Podiatric services provided or arranged for, or under
direction of, the supervising physician.
   (b) Optometric screening and advice for low-vision cases by a
licensed ophthalmologist or optometrist.
   (c) Dental screening for the purpose of apprising the participant
of the necessity of regular or emergency dental care.
   (d) Such other services within the concept and objectives of adult
day health care as may be approved by the department.



14552.  In order to obtain certification as a provider of adult day
health care under this chapter and Chapter 7 (commencing with Section
14000), the following standards shall be met:
   (a) The provider shall have met all other requirements of
licensure as an adult day health care center pursuant to Chapter 3.3
(commencing with Section 1570) of Division 2 of the Health and Safety
Code.
   (b) The provider shall comply with requirements of this chapter
regarding program and scope of services.
   (c) The provider shall have appropriate licensed personnel.
   (d) The provider shall employ required personnel for furnishing of
required services pursuant to Section 14550 consistent with commonly
accepted professional standards.
   (e) The provider shall afford to each participant all rights,
including the right to be free from harm and abuse, identified in the
rules and regulations adopted pursuant to Section 1580 of the Health
and Safety Code.
   (f) A provider serving a substantial number of participants of a
particular racial or ethnic group, or participants whose primary
language is not English, shall employ staff who can meet the cultural
and linguistic needs of the participant population.
   (g) A provider shall have organizational and administrative
capacity to provide services under the provisions of this chapter.



14552.2.  (a) "Program plan" means a written description of the
adult day health care center's philosophy, objectives, and processes
for providing required services to the participant populations.
   (b) The program plan shall include any of the following elements,
as requested by the California Department of Aging, and shall be
submitted as required in Section 14574.1:
   (1) The total number of participants the center proposes to serve,
or currently serves, daily.
   (2) A profile of the participant population the center proposes to
serve, or currently serves, that includes a description of the
specific medical, social, and other needs of each population.
   (3) A description of the specific program elements and services
that addresses the medical, social, and other needs of each
participant population that the center proposes to serve, or
currently serves, as specified in paragraph (2). "Program elements"
means the components of an adult day health care program, as
specified in Section 14550.
   (4) A description of the specialized professional and program
staff that will provide, or currently provide, the adult day health
care center's program services, as specified in paragraph (3), and
that staff's responsibilities. The plan shall demonstrate that the
adult day health care center is organized and staffed to carry out
the requirements as specified in the regulations adopted pursuant to
Section 1580 of the Health and Safety Code.
   (5) An in-service training plan for each center staff member to
commence within the first six months of employment. The training plan
shall address, at a minimum, the specific medical, social, and other
needs of each participant population the center proposes to serve,
as specified in paragraph (2).
   (6) A sample individual plan of care for each specialty population
the adult day health care center proposes to serve, or currently
serves, and a sample of a one-week schedule of daily program services
for each sample individual plan of care. The individual plan of care
shall demonstrate the specific medical, social, and other needs of
each participant population the adult day health center proposes to
serve.
   (7) A plan for a behavior modification program if such a program
will be used as a basic intervention for meeting the needs of a
special population, such as persons with developmental disabilities
or persons with mental disabilities.
   (c) This section shall be implemented only to the extent funds are
made available for the purposes of this section in the annual Budget
Act or another statute.
   (d) The implementation of the program plan requirements does not
require adoption of regulations pursuant to the Administrative
Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code).



14552.5.  Pursuant to Section 14043.46, the department may implement
a one-year moratorium on the certification and enrollment into the
Medi-Cal program of new adult day health care centers.



14553.  An adult day health care provider shall establish written
policies and procedures, which shall have prior approval of the
department, unless otherwise specified in an interagency agreement
entered into pursuant to Section 1572 of the Health and Safety Code,
for continuously reviewing the quality of care, performance of all
personnel, the utilization of services and facilities, and costs.
Information derived from the review shall be made available to the
department, unless otherwise specified in an interagency agreement
entered into pursuant to Section 1572 of the Health and Safety Code.



14553.1.  The adult day health care center's policies and procedures
shall include provisions for the following:
   (a) Designating the staff who will serve in the required positions
during a short-term absence or short-term vacancy, as defined in
subdivision (o) of Section 1570.7 of the Health and Safety Code, of
required staff.
   (b) Providing coverage for required staff in the event of a
long-term absence or long-term vacancy, as defined in subdivision (k)
of Section 1570.7 of the Health and Safety Code.
   (c) Ensuring continuity of services for participants during staff
absences.



14554.  The adult day health care provider shall maintain a complete
standard medical record for each participant, including records of
treatment rendered by a subcontractor, according to specifications
established by the department and as may be further specified by the
California Department of Aging.


14555.  Each adult day health care provider shall establish a
grievance procedure under which participants may submit their
grievances. Such procedure shall be approved by the department prior
to the approval of the certification. The department shall establish
standards for such procedures to insure adequate consideration and
rectification of participant grievances. A provider shall make
written findings of fact in the case of each grievance processed, a
copy of which shall be transmitted to the participant. If the
Medi-Cal participant has an unresolved grievance, the fair hearing
provided in Chapter 7 (commencing with Section 10950) of Part 2 of
this division shall be available to resolve all grievances regarding
care and administration by the adult day health care provider. The
findings and recommendations of the department, based on the decision
of the hearing officer, shall be binding upon the adult day health
care provider.